Telematics in geriatrics - potentials, limitations, and experience

Modem telecommunication technology (telematics) has the potential to improv e the quality of life for elders with physical and mental impairments as we ll as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-c enters. This can be viewed as a unique opportunity to establish and maintai n instant and personalized access to various medical services in a situatio n where increasing needs are opposed to decreasing resources. However, it i s not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its ap plicability and feasibility, but there are still no larger trials showing t hat maintenance or enhancement of autonomy can be achieved effectively by u sing new technologies. This article reviews the literature on telematics in geriatrics and present s data of a tele-rehabilitation project ("TeleReha", conducted at the Berli n Geriatric Center) which comprised mobility-impaired patients (N=13, mean age 72 yrs), care giving relatives (N=8), and geriatric professionals. Netw orking was established using ISDN technology with videophones or PC-based v ideoconferencing systems. Results showed that participants regard telecommu nication devices as a valuable resource for their informational and communi cational needs. Use of telecommunication systems was inversely related to p hysical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable cont acts with non-professionals (relatives, other participants). Despite experi enced technical problems, use of telecommunication systems was evaluated mo re positively in the post-test as compared to the pre-test. In summary, current experience suggests that telematics can be used efficie ntly by geriatric patients and by relatives and professionals caring for th em. However, evidence for a medically and economically effective use is sti ll scarce. A lack of structural and organizational concepts for geriatric t elematics initiatives can be identified which in part may be due to the fac t that the considerable potentials of telematics applications are still lar gely unrecognized by geriatricians.